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Resumen Como se comentó en el artículo anterior (Estudios de cohortes. 1ª parte. Descripción, metodología y aplicaciones), los estudios de cohortes se caracterizan por ser observacionales, longitudinales y analíticos; y en todos ellos se debe considerar una exposición o "factor de exposición", un período de seguimiento, eventuales pérdidas de seguimiento y el desenlace de un resultado. Se han propuesto modificaciones y variantes al diseño del estudio de cohortes tradicional. Se describen de forma resumida, las características principales de los estudios de cohortes con base poblacional, de cohortes bidireccional o ambispectivo; y de otras variantes: según número de cohortes (única y múltiple), de acuerdo al tipo de reclutamiento de la población a estudio (cerrada y abierta), según el tipo de exposición (fija y dinámica); estudio de casos y controles anidado, cohorte-caso; y cohortes ocupacionales (simple con población de referencia externa, simple con grupo de referencia interna y de cohortes múltiples). Finalmente, se desarrollan algunos ejemplos de la literatura de las variantes de cohortes más frecuentes. El objetivo de este manuscrito fue generar un documento de estudio referente a las modificaciones y variantes del diseño del estudio de cohortes.
As we mentioned in a previous article (Cohort studies. 1st part. Description, methodology and applications), cohort studies are characterized by being observational, longitudinal and analytical studies; and in all of them an exposure, a follow-up period, eventual loss of follow-up; and an outcome should be considered. A number of modifications and variants to the traditional cohort study design have been proposed. A summary with the main characteristics of population-based cohort studies, bidirectional cohorts, and of other variants according: to the number of cohorts (single and multiple), to the recruitment of the study population (closed and open), to the exposure (fixed and dynamic); nested case-control study, cohort-case, and occupational cohorts (simple with external reference population, simple with internal reference group and multiple cohorts), are described. Finally, examples of the literature of the most frequent cohort variants are developed. The aim of this manuscript was to generate a study document referring to some of the modifications and variants of cohort studies.
Assuntos
Humanos , Estudos de Coortes , Estudos Longitudinais , Pesquisa Biomédica/normasRESUMO
To better practice the Deepening Standardization Reform Plan,announced by the State Council,to promote the leadership of standard in healthy development of preventive medicine and public health,the Chinese Preventive Medicine Association (CPMA) established the Standardization Committee of Chinese Preventive Medicine Association (SC-CPMA).The SC-CPMA was responsible for the work of standardization developments of CPMA,including review of project's qualification and proposal,pre-qualification and qualification review of standard,publicity and training of standard,evaluation of standard implementation,review of standard,and public response monitoring of the standard.At December 13,2018,CPMA published two group standards,the Technical specification of data processing for large population-based cohort study (T/CPMA 001-2018) and Technical specification of data security for large population-based cohort study (T/CPMA 002-2018).This was the first time that a group standard was published by CPMA and produced for large cohort study's establishment and research.These two standards were the milestones for public health areas and the academic achievement of team,leading by Dr.Li Liming,after decade of research and practice.The two standards were developed based on the China Kadoorie Biobank Study and aimed to formulate professional standards and standardized operation procedures that met the nationals conditions,with strong operability and generality of population cohort establishments.The group standards were also aimed to guide the establishments for other population-based cohort studies to maximum support the decision making and practice for disease control and prevention.The increasing disease burden of non-communicable disease (NCD) became severe public health problem and the etiology for NCD is complex.Large cohort studies,which became more popular recently,played an important role in observation and explanation of NCD etiology and risk factors.Under the current situation with growing number of large cohort studies,it is necessary to have a standard,which could be shared and used to guide other professional as critical scientific protocols.CPMA was committed to promoting the development of group standards in the field of public health,and supporting the implementation of the Healthy China Strategy.
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To better practice the Deepening Standardization Reform Plan,announced by the State Council,to promote the leadership of standard in healthy development of preventive medicine and public health,the Chinese Preventive Medicine Association (CPMA) established the Standardization Committee of Chinese Preventive Medicine Association (SC-CPMA).The SC-CPMA was responsible for the work of standardization developments of CPMA,including review of project's qualification and proposal,pre-qualification and qualification review of standard,publicity and training of standard,evaluation of standard implementation,review of standard,and public response monitoring of the standard.At December 13,2018,CPMA published two group standards,the Technical specification of data processing for large population-based cohort study (T/CPMA 001-2018) and Technical specification of data security for large population-based cohort study (T/CPMA 002-2018).This was the first time that a group standard was published by CPMA and produced for large cohort study's establishment and research.These two standards were the milestones for public health areas and the academic achievement of team,leading by Dr.Li Liming,after decade of research and practice.The two standards were developed based on the China Kadoorie Biobank Study and aimed to formulate professional standards and standardized operation procedures that met the nationals conditions,with strong operability and generality of population cohort establishments.The group standards were also aimed to guide the establishments for other population-based cohort studies to maximum support the decision making and practice for disease control and prevention.The increasing disease burden of non-communicable disease (NCD) became severe public health problem and the etiology for NCD is complex.Large cohort studies,which became more popular recently,played an important role in observation and explanation of NCD etiology and risk factors.Under the current situation with growing number of large cohort studies,it is necessary to have a standard,which could be shared and used to guide other professional as critical scientific protocols.CPMA was committed to promoting the development of group standards in the field of public health,and supporting the implementation of the Healthy China Strategy.
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Long-term follow-up for end point is an extremely important and arduous task in large population-based cohort studies, which is also the key to the success of large cohort studies. Thus, the fundamental question of the achievements above is how to construct a large population- based cohort in a standardized way. The Chinese Preventive Medicine Association coordinated experienced researchers from Zhejiang Provincial Center for Disease Control and Prevention and other professional institutes to write up the group standard entitled Technical specification of long-term follow-up for end point in large population-based cohort study (T/CPMA 002-2019). The standard is drafted with principles of emphasizing the scientific, normative, applicability, and feasible nature. This group standard recommended the follow-up target population, time, content, methods, quality control, and indicators assessment. The standard aims to guide the large population-based cohorts that have been or intended to be established in China, including national cohorts, regional population cohorts, and special population cohorts, hence, to improve domestic scientific research level and the international influence, and to support decision-making and practice of disease prevention and control.
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Large population-based cohort study is an important resource for population disease prevention and control, the results of which provide scientific basis for individualized treatment and precise prevention, and it is also the key strategic content of precision medicine. The Chinese Preventive Medicine Association coordinated experienced researchers from the Chinese Academy of Medical Sciences and other professional institutes to write up the group standard entitled Technical specification of management for field investigation in large population-based cohort study (T/CPMA 001-2019). Based on the research of large population-based cohort study in China and the principle of scientific, normative, applicable, and feasible, the standard proposed six aspects of management requirements including institutional arrangement, personnel composition, equipment, materials, documents and finance, as well as the basic requirements of the on-site investigation, the requirements of each position and the overall quality control requirements, etc.. The standard aims to guide the large population-based cohorts that have been or intended to be established in China, including national cohorts, regional population cohorts, and special population cohorts, hence to improve scientific research level, accelerate scientific research output and provide localization basis for disease prevention and control in China.
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A population-based cohort study on pediatric infectious diseases was established at Khanh Hoa Province, central Vietnam in 2006, to determine the etiology and risk factors for severe pediatric infectious diseases (SPID) such as acute respiratory infection (ARI), diarrhea and dengue which are the major causes of under 5 mortality. A population census survey was conducted in Nha-Trang and Ninh-Hoa to collect demographic, social-behavioral data and disease burden on SPID. The study site covered a population of 353,525 residing in 75,826 households with 24,781 children less than 5 years. Hospital databases from two hospitals covering the region were obtained. Linking the census and hospital databases, we were able to investigate on a variety of SPID such as environmental tobacco smoking exposure and increased risked of pediatric pneumonia hospitalization, population density, water supply and risk of dengue fever and animal livestock and risk of hospitalized diarrhea. To determine incidence, viral etiology and risk factors for pediatric ARI/pneumonia, we setup a population based prospective hospitalized Pediatric ARI surveillance at Khanh Hoa General Hospital, Nha-Trang in February 2007. The study has revealed RSV, rhinovirus and influenza A as major viral pathogens, role of multiple viral infection and its interaction with bacteria in the development of pneumonia. In addition, we are also conducting a birth cohort study to investigate the incidence of congenital infection and its impact on physical-neurological development, and role of host genetic polymorphism on SPID hospitalization in Vietnam. Population mobility, high cost of regular census update and low mortality are the challenges.
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A population-based cohort study on pediatric infectious diseases was established at Khanh Hoa Province, central Vietnam in 2006, to determine the etiology and risk factors for severe pediatric infectious diseases (SPID) such as acute respiratory infection (ARI), diarrhea and dengue which are the major causes of under 5 mortality. A population census survey was conducted in Nha-Trang and Ninh-Hoa to collect demographic, social-behavioral data and disease burden on SPID. The study site covered a population of 353,525 residing in 75,826 households with 24,781 children less than 5 years. Hospital databases from two hospitals covering the region were obtained. Linking the census and hospital databases, we were able to investigate on a variety of SPID such as environmental tobacco smoking exposure and increased risked of pediatric pneumonia hospitalization, population density, water supply and risk of dengue fever and animal livestock and risk of hospitalized diarrhea. To determine incidence, viral etiology and risk factors for pediatric ARI/pneumonia, we setup a population based prospective hospitalized Pediatric ARI surveillance at Khanh Hoa General Hospital, Nha-Trang in February 2007. The study has revealed RSV, rhinovirus and influenza A as major viral pathogens, role of multiple viral infection and its interaction with bacteria in the development of pneumonia. In addition, we are also conducting a birth cohort study to investigate the incidence of congenital infection and its impact on physical-neurological development, and role of host genetic polymorphism on SPID hospitalization in Vietnam. Population mobility, high cost of regular census update and low mortality are the challenges.
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OBJECTIVE: The goal of the present study was to estimate the risk ratio of herpes zoster among systemic lupus erythematosus patients after disease onset compared with a cohort of patients without systemic lupus erythematosus over a three-year period. METHODS: A nationwide population-based cohort study using the National Health Insurance Research Database identified 10,337 new cases of systemic lupus erythematosus as the study cohort. In addition, 62,022 patients without systemic lupus erythematosus, who were matched for age, gender, and date of systemic lupus erythematosus diagnosis, were used as the comparison cohort. These cohorts were followed-up for three years. A Cox proportional hazard regression was performed to estimate the risk ratio of herpes zoster, with adjustments for age, gender, level of insurance, urbanization level, geographic region, comorbid medical conditions, average daily dosage of corticosteroids, and the use of immune-modulation agents. RESULTS: Compared to patients without systemic lupus erythematosus, the crude risk ratio and adjusted risk ratio of herpes zoster among systemic lupus erythematosus patients were 7.37 (95 percent confidence interval 6.75-8.04) and 2.45 (95 percent confidence interval 1.77-3.40), respectively. Stratified by gender, the adjusted risk ratio of herpes zoster was 2.10 (95 percent confidence interval 1.45-2.99) in women and 7.51 (95 percent confidence interval 2.89-19.52) in men. Stratified by age, the adjusted risk ratio peaked in systemic lupus erythematosus patients who were aged 18 to 24 years (risk ratio 8.78, 95 percent confidence interval 3.08-24.97). CONCLUSION: Based on nationwide population-based data, there is an increased risk of herpes zoster in systemic lupus erythematosus patients compared with non-systemic lupus erythematosus patients, particularly among males and patients aged 18 to 24 years. Further research on the associated risk factors for herpes zoster in systemic lupus erythematosus patients is needed.